Telehealth Resources

Please refer to the following link for Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 public health emergency: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. 

Telehealth can provide many benefits for your practice and your patients, including increased
access to care and convenience.  Many health care providers may be able to provide telehealth visits for a variety of care needs, including routine medical care, urgent care or pandemic-related visits that may otherwise take place an urgent care center or emergency department.

As a participating provider, you can be reimbursed for telehealth when services are provided to members enrolled in the following lines of business: 

  • Commercial: traditional indemnity, HMO, PPO, EPO and point-of-service products, and policies offered on and off of the New York State of Health
  • Medicare: Medicare, Medicare Advantage (PPO/HMO), Medicare Part D
  • New York State Government Programs: Medicaid Managed Care (MMC), Health and Recovery Plan (HARP), and Child Health Plus (CHP) 
    • MMC: MyHealthSM
    • HARP: MyHealth PlusSM
    • CHP: Child Health Plus
  • Special Programs: Healthy NY and the Essential Plan

Please refer to the member’s benefits for specific contract benefits and limitations, including member cost-sharing responsibility (e.g., copay, deductible, coinsurance) before rendering telehealth and telemedicine services. Coverage varies by line of business, and coverage limits apply just as they do for similar services provided in a face-to-face setting.

Review our Corporate Medical Policy No. 1.01.49 – Telemedicine and TelehealthOpen a PDF for additional information. 

Our members receiving care via telehealth must provide consent prior to a telehealth visit.  We do not require a written consent form, but patient consent must be documented in the patient’s medical record.

Modifiers

Along with the appropriate CPT® or HCPCS code, the appropriate modifier should be billed, when applicable.

Modifier Description Note/Example
93 Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunication system Modifier “93” will only be allowed when appended to the CMS audio allowed services located on the CMS List of Telehealth Services for Calendar Year 2022 (click link to select and download the ZIP file, then open the downloaded Excel file and refer to Column D).

 

95 Synchronous telemedicine service rendered via real-time interactive audio and video telecommunication system Modifier "95" may only be appended to the specific services listed in Appendix P of the AMA's CPT code book. The CPT codes listed in Appendix P are for services that are typically performed face-to-face but may be rendered via a real-time (synchronous) interactive audio-visual telecommunication system.
FQ Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunication system Modifier “FQ” will only be allowed when appended to the CMS audio allowed services located on the CMS List of Telehealth Services for Calendar Year 2022 (click link to select and download the ZIP file, then open the downloaded Excel file and refer to Column D).
GT Via interactive audio and video telecommunication systems Modifier "GT" is only for use with those services provided via synchronous audio and video for which modifier "95" cannot be used.
GQ Via asynchronous telecommunications system

Modifier “GQ” is used for services delivered via an asynchronous telecommunications system.* 
*During the COVID-19 public health emergency, New York state has re-purposed this modifier to identify Medicaid covered services performed via audio only (telephone). 

G0
(zero)
Modifier “G0” is used to report telehealth services for the diagnosis, evaluation, or treatment of symptoms of an acute stroke.  

 

Place of Service (POS) Coding

POS Code Description Note/Example
02 The location where health services and health-related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health-related services through telecommunication technology.   1/1/22- CMS revised the descriptor for telehealth.  POS 02 is now used when the patient is located in any location other than home.  
10 The location where health services and health-related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.  1/1/22- To assist with claim adjudication coordination with other payers, CMS created this POS to represent when the member is receiving services in their home. The Health Plan accepts this POS as of  1/1/22.  
11 Use when provider is office-based.  Any applicable modifier should also be reported. During the COVID-19 public health emergency, CMS instructs providers to report the appropriate POS code where the provider is located and to also include modifier “95.”
12 Use when provider is home-based. Any applicable modifier should also be reported. During the COVID-19 public health emergency, CMS instructs providers to report the appropriate POS code where the provider is located and to also include modifier “95.”
IE Browser Modal